Anti- and pro-arrhythmic effects of cardiac resynchronization therapy: Point of view

Joseph R. DiPalma, Steven P. Kutalek, Howard Eisen, J. Yasha Kresh, Amir Pelleg

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations


Cardiac resynchronization therapy (CRT) in patients with heart failure and bundle branch block (BBB) improves regional muscle mechanics and mechanical pump function of the heart. In addition, modulation of wall motion timing and contraction can exert an antiarrhythmic effect, reducing the potential of sudden cardiac death. This effect of CRT could also be attributed to the improvement in excitation-contraction coupling, mechanical synchronization, and improved myocardial perfusion. However, it can be hypothesized that the BBB results in a concealed reentry, in which a delayed depolarization wave re-enters during phase two of the action potential. This concealed phase 2 reentry can lead to early after depolarizations and cardiac arrhythmias. By synchronizing the two ventricles, CRT eliminates the reentry substrate and the resulting arrhythmias. This hypothesis and the potential arrhythmogenic effects of CRT are discussed with regard to ventricular remodeling and mechano-electrical feedback in this setting.

Original languageEnglish (US)
Pages (from-to)190-195
Number of pages6
JournalAmerican journal of therapeutics
Issue number2
StatePublished - Mar 2008

All Science Journal Classification (ASJC) codes

  • Pharmacology
  • Pharmacology (medical)


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